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Gross distal caries
From: Terry Pannkuk
Sent: Tuesday, January 24, 2012 3:29 AM
Subject: [roots] Whatever it takes
This lower second molar presented with gross distal caries and
difficult isolation challenges complicated by the patientís very
narrow arch. We talked about block out resin, Dycal, Oraseal,
and other strategies. My strategy for this one was to send him
to the oral surgeon and get the wisdom tooth out, during the
month interim with CH.
I also simplified the process by packing the distal canal only
a couple weeks ago, then scheduling a separate appointment to
pack the mesial required time and were more complex with very
difficult access and curvatures. Today the distal wall of Cavit
was nicely sealed and I didnít have to take the temp out on the
distal aspect making it a very simple appointment.The previous
appointment was simple too because the Dycal seal on the distal
held up perfectly for the shorter amount of time required to pack
just the distal. I cleaned and shaped to the RT, but fit the cone
to the blotting point at 24 mm on this case, the working length
was 24.75mm. The puff pretty much shows that.(small as practical)
Multiple advantages dividing the visits up:
1. More irrigant action, more recapitulations.
2. Better isolation and asepsis.
3. Patientís jaw less fatigued.
Therefore the overall result is better
Fitting a cone is an important diligent step which insures success
in numerous ways, not necessarily related to the quality of obturation.
Controlling the case aseptically with a diligent strategy
for access, C & S, interim temporization, and obturation from start
to finish is the key - Terry